Ebola response on ‘knife’s edge’ as timing key, WHO says

GENEVA (AP) — The World Health Organization is accelerating its efforts with nine countries neighboring Congo to try to prevent the current Ebola outbreak from spreading beyond the border, WHO’s director for Africa said Wednesday, as a colleague warned that the next few weeks will determine whether the virus can be kept under control.

The top two priority countries are Central African Republic and the Republic of Congo near the epicenter of the outbreak, Matshidiso Moeti told a World Health Assembly session. In the Republic of Congo, for example, WHO is working with government officials “to stop functioning” an active market on its side of the Congo River.

The other countries are Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and, to a lesser extent, Uganda. WHO and governments are working to roll out “pre-position” supplies that might be needed if the virus spreads, Moeti said.

Congo’s health ministry on Wednesday announced six new suspected cases in the rural Iboko health zone in the country’s northwest and two in Wangata, a suburb of Mbandaka, a city of 1.2 million people on the Congo River. There are now 28 confirmed Ebola cases, 21 probable ones and nine suspected.

Overall, since the outbreak of the often deadly hemorrhagic fever was confirmed by the ministry on May 8, the death toll stands at 27, with three deaths confirmed as Ebola.

“We’re on the epidemiological knife’s edge of this response. The next few weeks will really tell if this outbreak is going to expand to urban areas or if we’re going to be able to keep it under control,” Dr. Peter Salama, the WHO emergencies chief, told the WHA session.

Factors that have created concerns that the outbreak has the potential to expand include the spread of confirmed cases to Mbandaka city and the fact that five health workers have been infected, signaling “a potential for further amplification.”

Front-line workers are especially at risk of contracting the virus, which spreads in contact with the bodily fluids of infected people, including the dead.

Finally, Salama said, the outbreak has “three or four separate epicenters,” making it more challenging to contain.

“It’s really the detective work of epidemiology that will make or break the response to this outbreak. It’s documenting how people are getting infected and therefore managing to control the transmission,” Salama said.

“We are following three separate chains of transmission,” he said. “One associated with a funeral that took place in a neighboring town of Bikoro; one associated with a visit to a health care facility more than 80 kilometers (50 miles) away in the small village of Iboko and one where we’re still gathering data on that’s related to a church ceremony.”

Each has the potential to expand if not controlled, Salama said.

WHO began vaccinations this week and is using a “ring vaccination” approach, targeting the contacts of people infected or suspected of infection and then the contacts of those people.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.

WHO Director-General Tedros Adhanom Ghebreyesus said simply: “We are watching it around the clock, 24-7.”